Mission and ChallengeObjectivesPartners

EHCI Mission

Develop training and workforce solutions for the provision of quality primary care to underserved populations through support and transformation of primary care health workforce training partnerships.

Areas of focus:

• FQHC-residency training partnerships
• Consultation services
• Health workforce research
• Policy solutions for primary care training

The Challenge

Health centers and the specialty of family medicine share the vision of breaking down barriers to access so that every American has a patient-centered medical home. Unfortunately, in addition to their common values of service, health centers and residencies also share the burden of a health workforce crisis. As a result of decreased interest in primary care, the recent expansion in numbers of health centers and a chronic problem of recruitment and retention of health care providers to underserved areas, there is a shortage of Family Physicians within health centers. The current health workforce crisis threatens the safety net system and the vulnerable population it serves. The crisis in primary care and a lack of secure funding threaten the survival of family medicine residency programs. New models of training primary care physicians in health centers are necessary to assure adequate health workforce to staff our nation’s safety net clinics.

The Response

Over the past three years, three organizational partners—Northwest Regional Primary Care Association (NWRPCA), the University of Washington Family Medicine Residency Network/UW Department of Family Medicine and Community Health Association of Mountain/Plains States (CHAMPS)—have worked together to address this issue. The Education Health Center Initiative (EHCI or “the Project”) has produced a foundation of qualitative and quantitative evaluation of residency training in health centers, forged a coalition of health center and residency representatives throughout a ten-state region, and taken preliminary steps toward creating a model for training primary care physicians in the health care safety net. The Project has demonstrated that training family physicians in health centers helps meet the health workforce needs of the underserved by enhancing the recruitment of family physicians to such centers. Project research has also shown that physicians who are trained in health centers are twice as likely to work in underserved settings and four times more likely to work in health centers after completing their residency. However, qualitative assessments reveal that the affiliation between health centers and primary care residency programs is hindered by financial, administrative and governance barriers, evidenced by the University of Washington Department of Family Medicine’s national survey of all Family Medicine Residencies in the US which demonstrated that only 9% of residents are trained in federally-qualified health centers.

Objectives

Continue identifying existing resources related to effective health center-family medicine residency affiliation.

Develop new resources as needed and with adequate financial support. The Project partners are developing 1) an economic accounting model of residency-health center affiliation based on detailed analysis of existing programs--essentially, an economic analysis of the costs of training residents in health centers; 2) an analysis of governance issues and potential solutions, as well as the administration requirements of the Education Health Center; and 3) a toolkit for health centers and residencies interested in partnering. The first will include a comparison of the costs of training in a standard residency, one affiliated with a health center, and a health center not doing training.

Provide trainings/workshops. The partners developed and conducted a day-long workshop at the federal Regions VIII and X Fall Primary Care Conference held in Denver in 2008, hosted by CHAMPS and NWRPCA. The training provided, for interested health centers and residencies across the country, an intensive workshop on the legal, financial, clinical, and operational issues involved in health center-family medicine residency affiliation. Click here to hear recordings of experts leading discussions in the legal, fiscal, administrative/operational and mission/governance areas. A further training that will bring together experts from around the country will meet for a day and a half at the Fall Primary Care Conference, Denver, and will take place Oct 23 - 24. If you would like to be added to a list to receive more information as it becomes available email Steve Seely at sseely@nwrpca.org.

Conduct presentations/general outreach on the Project themes at relevant conferences/meetings.

Conduct relevant research. The University of Washington Department of Family Medicine has finished a national survey of all FMRs in the US regarding their affiliation with health centers. Preliminary data tell us that there is a cohort of approximately 32 residencies that are fully affiliated with health centers. This represents 9% of residencies nationally. This is unchanged from previous estimates 15 years ago; apparently, while training residents in health centers remains a sound practice, it has not resulted in increased affiliation. This finding demonstrates a large potential for improvement and an argument for continued work on trying to remove the barriers to health center-family medicine residency training around mission, governance, administration, and financing.

Seek funding for Education Health Center Demonstration Projects. The partners are working with the National Association of Community Health Centers, the American Academy of Family Physicians, and Congressional representatives to find the correct language and vehicle for demonstration project funding, and are also investigating foundational and state government support for these ideas.

Seek funding for on-going Project work, with NWRPCA serving as the fiscal sponsor for the Project.

The Partners

The University of Washington Family Medicine Residency Network/Department of Family Medicine

The University of Washington Family Medicine Residency Network is a group of family medicine residency programs related to each other by geography and university affiliation. The Network consists of eighteen affiliated residency programs located within the WWAMI region - Washington, Wyoming, Alaska, Montana and Idaho. We have twelve programs in Washington, two programs in Idaho, two programs in Wyoming, and one program each in Montana and Alaska.

The Network exists to promote excellence in family medicine residency education, provide academic leadership, and to respond to societal needs for family physicians. The quality of the individual programs is high, reflected in the number and quality of applicants and residents, the excellence of the faculty, and the strong support of the sponsoring hospitals in providing up-to-date facilities and skilled staff.

For more information on the 18 residency programs, please download the Network brochure.

The Northwest Regional Primary Care Association

Northwest Regional Primary Care Association (NWRPCA) is a non-profit membership association that works to ensure equal access to primary health care for all residents living in Alaska, Idaho, Oregon and Washington. We support and strengthen community-based health centers as they deliver primary health care to urban, rural and frontier communities throughout the Northwest. We believe that the key to expanding access for medically underserved communities is strengthening health centers so that they can provide high quality, cost effective, comprehensive health care services throughout the region.

Community Health Association of Mountain/Plains States

Community Health Association of Mountain/Plains States (CHAMPS) is a nonprofit membership association of community, migrant and homeless health centers (CHCs) in Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming. CHAMPS was founded in 1985 to unite Region VIII health centers in an advocacy and mutual support network of these community-based providers of primary care and related services for underserved communities in the Mountain and Plains states.